Annual report - FY 2000 (Long Term Services Division)

Department of Health
Long Term Services Division
Annual Report
Fiscal Year 2000
July 1, 1999 through June 30, 2000
*
“ Los Remedios”
Inside This Report
Introduction to the Long Term Services Division 3
Central Registry 6
Family Infant Toddler Program 8
Developmental Disabilities Waiver 10
State General Fund— Children and Adults 13
Disabled and Elderly Waiver 14
Medically Fragile Waiver 16
Traumatic Brain Injury Services 18
Bibliography 19
Glossary 20
Artwork
Cover
“ Los Remedios”, Detail, 1996
Artist: Glenn Strock
Courtesy of La Familia Medical Center
Page 3
“ Best Friend” 1999
Watercolor
Artist: Helene Valdez
Courtesy of Very Special Arts
Page 10
Trina Brillhart 2000
Photograph, hand- made paper frame
Courtesy of Very Special Arts
Page 13
“ Untitled”, 10/ 2000
Designer: Joe Stephenson
Painters: Christina Caraveo, Ian Donaldson, Casey Ferguson, Carlan Gettman, Rachel Hardy, Cindy Luna,
Pete Martindale, Diana Phillips, Linda Plageman, Adam Smith, Joe Tenorio, Chris Travis, Hoka Skenandore,
Sandy Ward, Melvin Lucero, Tal Maya’an, Damian Moya
Courtesy of Very Special Arts
Page 14
“ El Senador”, Detail, 1999
Artists: Cynthia and J. Mark Rowland
Public Art Program
Urban Enhancement Fund
Page 2 Long Term Services Division
Fiscal Year 2000 Annual Report
Visit us on the Internet:
www. health. state. nm. us/ ltsd/ index. html
A bout 1 in 5 Americans have
some kind of disability, and 1
in 10 have a severe disability. Typi-cally,
the person who takes on the
role of primary helper for the person
with a disability is a relative. As a
person grows older, the likelihood
of having a severe disability in-creases.
About 250,000 New Mexicans have
a disabling condition and about half
of these individuals have a severe
disability. While not all of these indi-viduals
need long term care ser-vices,
their needs most likely mean
the involvement of family members
as decision- makers and providers
of care. Families can benefit from
long term care interventions be-cause
the care for the person with a
disability gives assistance and relief
for family caregivers.
Introduction to the Long Term Services Division
The role of the Long Term Services
Division ( LTSD) is to promote the
potential of the individual with or at
risk for a disability to live at home
within their families and communi-ties.
Services are wide- ranging: job
support; family counseling; thera-pies
to promote independence in
physical activities; communication
skill- building; assistance or training
with basic activities of daily living,
like bathing, dressing, eating,
household chores like meal prepa-ration,
or activities in the commu-nity,
such as work, shopping, and
What Has Been Done?
• A greater number of children and
adults received services through all
programs managed by the LTSD.
• Results of a cost study led to rate
changes, and in most cases
increases, in funding for certain
services.
• A quality management/ improvement
system was designed in collaboration
with the Division of Health
Improvement to review provider
services and overall performance.
• More adults with developmental
disabilities had jobs in the community.
• Improvements to the DD Waiver
Central Registry data system resulted
in better information for and about
applicants .
• Improvements to the FIT Database
resulted in better information about
birth to three year olds in Early
Intervention Services.
• Adults with disabilities were provided
with opportunities to be self-advocates
and form self- advocacy
support groups.
• Quarterly newsletters were published
• A video and brochure on the benefits
of LTSD services and supports were
developed and distributed.
What Needs To Be Done?
• Increase the number of people in all
programs.
• Give parents and consumers a chance
to manage their own services.
• Improve accountability from ourselves
and our providers for quality services.
• Promote inclusion and delivery of
services in natural – or community --
settings.
• Move closer to a settlement of the
Jackson class action lawsuit.
• Give families and consumers a
greater voice in advising state
government --- establish a consumer
council and a children’s advisory
council.
• Train providers to improve
understanding of performance
expectations.
• Coordinate for a smooth transition of
the Disabled and Elderly Waiver
Program to the Human Services
Department.
• Prepare for federal monitoring of
Waivers and Health Insurance
Portability and Accountability Act
requirements.
Mission Statement
The mission of the Long Term Services Division is to provide
services that promote quality life outcomes for persons with
disabilities and their families.
DID YOU KNOW…..
One out of every three people
in America over the age of 65
has a severe disability.
transportation, and other services.
Long term care may be provided in a
variety of settings – from 24- hour
residential/ day services to living inde-pendently
in one’s own home -- de-pending
upon the individual’s needs
and preferences, along with the avail-ability
of informal supports.
New Mexico is one of only seven
states in the nation that have closed
its publicly- funded institutions for
people with developmental disabili-ties.
As an alternative, individuals
who were previously- institutionalized
now receive services in their home
and community through the Develop-mental
Disabilities Waiver Program.
A conservative estimate of the num-ber
of people in New Mexico with a
developmental disability ( based on a
prevalence rate of 1.58%) is approxi-
Page 3
“ Best Friend”
mately 27,000
individuals of all
ages. Many of
these individuals
are school- age,
and receive
needed services
and supports
through the pub-lic
schools until
21 years of age.
Many others are
older New Mexi-cans,
living with
elderly caregiv-ers.
When life
transitions result in loss of supports,
these individuals pose a challenge to
funding agencies, such as LTSD.
Another challenge to LTSD is that
New Mexico is a large, predominantly
rural state. In rural frontier counties,
opportunities for education, employ-ment,
accessible transportation, tele-communications
are limited. Finding
qualified personnel who live in rural
areas, or who are willing to travel to
frontier counties, is a challenge to
long term care service providers.
Page 4 Long Term Services Division
Fiscal Year 2000 Annual Report
DID YOU KNOW…..
Almost 2 out of 3 counties in
New Mexico are frontier
counties ( that is, fewer than 6
people per square mile), which
experience the full impact of
rural isolation and remoteness.
LTSD provided long term care ser-vices
to approximately 8400 chil-dren
and adults. This represents a
10% growth in numbers served
over the year.
Since LTSD serves all geographic
areas of New Mexico, 58% of its
staff are distributed in regional of-fices,
rather than the central Santa
Fe base.
Budget resources ( including federal
Medicaid match) totaled $ 187 mil-lion
for the year. Of this amount,
94% is spent on services through
provider contracts. The largest
LTSD program is the Developmen-tal
Disabilities ( DD) Waiver, with
67% of the program budget; fol-lowed
by the Disabled and Elderly
Waiver Program, then by the FIT
Program.
In addition to contracts with ap-proximately
240 service providers,
the Division operates the Los Lunas
Community Program. LLCP serves
The Community Services Bureau
manages contracts/ agreements with
service providers for these funding
sources: DD Waiver, D& E Waiver,
Medically Fragile Waiver, Traumatic
Brain Injury, Gap Fund, and Adult
State General Fund. Responsibilities
include: development of program re-
D& E Waiver
13%
FIT Program
6%
Adult SGF
Services
4%
MF
Waiver
3%
TBI
1%
Administration
6%
DD Waiver
67%
STRUCTURE OF THE DIVISION
In the fiscal year beginning July 1999
through June 2000 ( FY 2000), the
Location Positions
Santa Fe Central Office 45
Albuquerque Metro
Office
30
Roswell
( Southeast Region)
8
Las Cruces
( Southwest Region)
9
Taos ( Northeast Region) 8
Gallup
( Northwest Region)
6
Total 106
FIGURE 1a
Geographic Distribution of LTSD Staff
FIGURE 2a
Budget Resources for FY 2000
DID YOU
KNOW…..
New Mexico is
the 11th fastest-growing
state
in the nation.
The fastest-growing
age
group in NM is
those over 65
years of age.
as a “ safety net” of crisis intervention
services, as well as a direct service
provider in the Metro and Northwest
Regions, dental, and therapies/
assistive technology services state-wide
for people with developmental
disabilities.
Page 5
quirements and oversight of service
provider compliance with require-ments
of various funding sources.
The Family Infant Toddler ( FIT)
Program provides a statewide sys-tem
of services and supports, using
three sources of funding: Medicaid,
State General and federal education
funds. Under the federal IDEA, Part
C program, LTSD is responsible for
assuring that all eligible children ages
birth to three receive appropriate
evaluations, services coordination
and early intervention services in a
timely manner. The unit has respon-sibilities
for public awareness, infor-mation
management and tracking,
eligibility determinations and meeting
requirements for a qualified person-nel
workforce. In addition, the pro-gram
manages a state- funded respite
program for children, birth to age 18,
with or at- risk for disabilities.
Regional Offices provide technical
assistance to service providers on
appropriate implementation of ser-vices.
Other responsibilities include
providing information to the public
and people in services, and follow- up
on incidences of abuse, neglect and
exploitation.
Located in the five regional offices,
the staff of Resource Supports pro-vide
training and technical assistance
to service providers, specializing in
the areas of case management, sup-ported
employment, behavioral sup-ports,
and individualized services and
supports. This unit manages a pre-service
and in- service training pro-gram,
inclusive of a tracking system
for private- sector employee compli-ance
with training requirements, for
DD Waiver providers. Individual ad-vocacy
services include mediation,
dispute resolution, coordination of
self- advocacy initiatives with people
in services. This unit plays a key role
in the implementation of the settle-ment
agreement for the Jackson law-
Program Area Provider Technical
Staff-
Trained
Assistance
Early
Childhood
1,773 Data Un-available
Supported
Employment
585 2,379
Individual
Advocacy
196 75
Competency
Training
11,877 1,145
Case
Management
79 179
Total( s) 14,510 3,778
FIGURE 3a
Training and Technical Assistance
suit. Competency training for case
managers and direct service staff in
community programs providing DD
Waiver services included entry- level
topics, as well as specialized topics
such as crisis intervention, medical
aspects, development of individual
service plans, and confidentiality.
Training and technical assistance
are provided by staff throughout the
Division, as well as training con-tracts.
One arm of the Program Develop-ment
Bureau facilitates strategic
planning in partnership with advi-sory
councils, develops status re-ports
on services and people with
disabilities, and produces the quar-terly
newsletter. The other arm of
this Bureau maintains the Central
Registry ( applicants for services)
and eligibility for the three Waiver
programs, as well as nursing home
placement for people with develop-mental
disabilities.
Two functions are performed under
Administrative Services: financial
supports and information/ data man-agement.
Financial supports in-clude
personnel, property and lease
management, purchasing, accounts
payable, fiscal grants management,
contracts management, and budg-eting.
Information/ data management
supports include communications,
data base applications and report
generation.
Key functions of the Division are:
• Public awareness and edu-cation
on services, access,
and program requirements
• Determination of eligibility for
services
• Development/ management
of contracts for services in
local communities statewide
• Quality management and
improvement, including
evaluation of service provid-ers
• Leadership in design and
implementation of statewide
supports, such as staff train-ing.
Tia Nelis encourages self- advocates to
speak for themselves and develop their
own leadership.
What Has Been Done?
• Developed a Pre-assessment
Case
Management service for
Disabled & Elderly Waiver
and Medically Fragile
Waiver registrants to keep
the Central Registry
information accurate and to
inform individuals about
LTSD services and other
services they can access
immediately.
• Changed the Central
Registry software making it
more user- friendly and
allowing access by the
Regional Offices.
• Added ICF/ MR ( Intermediate
Care Facility for the
Mentally Retarded) referrals
and admissions to the
Central Registry.
• Disseminated new Outreach
materials including the
LTSD Brochure and Video.
What Needs To Be Done?
• Examine demographic
trends and changing
service needs identified
through the Central
Registry to use in planning
services.
Central Registry
T he LTSD’s Central Registry is
a database used to manage
registration and allocation to the DD
Waiver, D& E Waiver, Medically
Fragile Waiver, DD State General
Fund services, and Intermediate
Care Facilities for the Mentally Re-tarded
( ICF/ MR). Information is
constantly changing as new indi-viduals
register and existing regis-trants
move into services.
Page 6 Long Term Services Division
Fiscal Year 2000 Annual Report
FIGURE 1b
Comparison of FY 99 and FY 2000 Individuals Actively Waiting For the DD and
D& E Waivers ( Counts are duplicative)
1917 2035
3027
2405
DD D& E
FY 99 FY 2000
Note: These numbers reflect the duplication of 1337 individuals registered for both Waiv-ers.
Individuals begin the registration
process at their local ISD County
Office. The ISD Office forwards the
registration information to the LTSD
Regional Office for assessment to
determine whether the individual
matches the criteria for the program
requested. An individual can regis-ter
for any or all programs for which
they believe they may meet eligibil-ity
criteria. Many individuals regis-tered
for both the DD and D& E
Waivers ( 1337 in FY 2000), result-
From FY 1999 to FY 2000, registra-tions
for DD services increased by
approximately 6%. The number of
registrants on the D& E Waiver Cen-tral
Registry was decreased by 21%
in the same period. In FY 2000, 464
persons were allocated into DD ser-vices
and 1700 into D& E services.
ing in a duplicate of 4440 registra-tions
for both programs. Allocations
are made based on registration date
and elderly caregiver status.
The LTSD sponsored New Mexico’s first
Self- Advocacy Conference
“ The general public should be
educated to know people with
special needs can still func-tion
in society.”
Lana Von Tress
Parent
Page 7
Most of registered applicants for the
D& E Waiver ( 64%) are aged 65
years and older. Children and
young adults generally register for
the DD Waiver because services
are a better fit, e. g. supported em-ployment,
the number of respite
hours allowed.
FIGURE 2b
Number of Individuals Registered for
DD Waiver Services By Age During FY
2000
FIGURE 3b
Number of Individuals Registered
for D& E Waiver Services By Age
During FY 2000
33
30
9
4
2
4
9
5
0 thru
3
4 thru
12
13 thru
17
18 thru
21
22 thru
34
35 thru
49
50 thru
64
65 and
Older
FIGURE 4b
Number of Individuals Registered for
MF Waiver Services By Age During FY
2000
The Medically Fragile Medicaid
Waiver Program had significantly
fewer registrants than the other Waiv-ers.
Ninety- six individuals registered
for that program in FY 2000.
The percentage of children registered
for the Medically Fragile Waiver is
81%. Adults must have a develop-mental
disability to meet the eligibility
criteria for the Medically Fragile
Waiver.
Children make up 43% of registrants
for the DD Waiver. There are very
few individuals in the 65 and older
category since the LTSD has a prior-ity
to serve applicants with elderly
caregivers.
“[ LTSD staff] help people get
out of nursing homes, get at-tendants
to provide personal
care, and assist people in go-ing
back to school: real ser-vices
that make a significant
difference in the lives of New
Mexicans with disabilities.”
Susan Lewis
Self- Advocate
DID YOU KNOW…..
In 1992, 15% of the total
US noninstitutionalized
population reported some
activity limitation due to
Participants enjoyed dancing at the Self- chronic health conditions.
Advocacy Conference.
102
411
360
292
517
254
78
21
0 thru 3
4 thru
12
13 thru
17
18 thru
21
22 thru
34
35 thru
49
50 thru
64
65 and
Older
32
34
21
23
109
261
376
1549
0 thru 3
4 thru
12
13 thru
17
18 thru
21
22 thru
34
35 thru
49
50 thru
64
65 and
Older
What Has Been Done?
• Developed an Improvement
Plan in response to U. S.
Department of Education
Monitoring Report.
• Over 300 Developmental
Specialist staff have been
certified.
• Over 300 Service Coordinator
staff have attended training.
• Published the FIT Program
Web Pages on the Internet.
• Modified child evaluation &
assessment system to
increase access and
appropriateness.
• Developed and implemented
the t h r ee year ICC
( Interagency Coordinating
Council) Strategic Plan.
• Developed an Interagency
Transition Agreement.
What Needs To Be Done?
• Establish special population
service initiatives.
• Implement the New Mexico
IDEA Part C Improvement Plan.
• Design and pilot a system of
monitoring and program
evaluation for the FIT Program.
• Continue work on the redesign
of the FIT financial system to
maximize resources and
support quality practices in
service delivery.
• Pilot IFSP- IEP document in
collaboration with State
Department of Education.
T he Family Infant
Toddler Program of
the LTSD is the lead
agency in New Mexico
providing early interven-tion
services to families of children
birth to three who have or who are
at risk for developmental delay.
The FIT program is responsible for
meeting the requirements of the
federal Individuals with Disabilities
Education Act ( IDEA) Part ' C'
through a multi- agency system of
services and supports.
Early Intervention services promote
a child's learning and development
during the important period of birth
through three years of age. The
FIT Program offers early interven-tion
services to eligible families
through over 30 early intervention
service providers across New Mex-ico.
Services are funded through a
combination of State, Medicaid and
federal IDEA Part C funds. Early
Family Infant Toddler ( FIT) Program
Page 8 Long Term Services Division
Fiscal Year 2000 Annual Report
Families, in collaboration with a team
of professionals, develop an Individu-alized
Family Service Plan ( IFSP).
The IFSP strategies, including ser-vices
and supports, are designed to
achieve family identified outcomes
through increasing the family’s ca-pacity
to meet the special needs of
the child.
FIGURE 1c
Number of Children and Families Referred for Services During FY 2000 by
Source of Referral
DID YOU KNOW…
Recent advances in brain
research indicate ninety percent
( 90%) of a child’s brain growth
occurs during the first three years
of life.
33
37
71
75
105
120
136
156
518
576
Navajo Nation
Childcare Worker
Public Health Division ( not CMS)
Early Intervention Provider
Social Service Agencies
Family / Friend
Educational Agencies
Children's Medical Services ( CMS)
Parents
Medical Care Personnel
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
Intervention services are also sup-ported
through agreements with the
State Department of Education, the
Children Youth and Families Depart-ment,
the Navajo Nation, State sup-ported
schools, and Headstart.
The FIT Program does not maintain a
list of applicants or have children
waiting for services. Services are
available in local communities state-
The FIT Program serves families of eligible wide.
children birth to three
Page 9
FIGURE 2c
Number of Children Determined Eligible in FY 1999 & FY 2000
( subset of the total number receiving services as children may have been
evaluated in a different year)
187
427
933
173
158
240
807
113
At risk,
Environmental
At Risk,
Medical/ Biological
Developmental
Delay
Established
Condition
FY 2000 FY 1999
During FY 2000 the FIT Program
served 3,057 eligible children, ap-proximately
3% of the general
population of children birth through
three years old. Children and fami-lies
served were located throughout
New Mexico, roughly proportionate
to the general population distribu-tion
of the state. Most children
were identified for services after
turning age two. The Family Infant
DID YOU KNOW…
Every dollar invested in quality
early childhood development
saves society $ 7 in remedial
education, welfare payments
and court and prison
expenses.
High/ Scope Perry
Preschool Study, 1994
“ When I started with the pro-gram
of early intervention, I
started becoming aware of the
opportunities… ( my daughter)
had to advance, to develop, and
to do what she is doing now.”
Blanca Hernandez
Parent
Region FY 1999 FY 2000
Metro 776 934
NW 327 457
NE 509 531
SW 580 671
SE 312 464
Total 2504 3057
* FY99 count contains potential duplicates.
FIGURE 3c
FIT Recipients by LTSD Region
Toddler Program conducted outreach
activities in FY 2000 which have re-sulted
in increased numbers of chil-dren
served over the previous year.
Most children are in services be-cause
of a delay in their develop-ment.
However, an increasing num-ber
of children are being identified
who have a medical condition, such
as low birthweight, which puts them
at risk for a developmental delay.
Services are delivered in the home,
childcare settings or other community
locations. The primary location for
the delivery of services, as specified
on the Individualized Family Service
Plans ( IFSPs) developed during fiscal
year 2000 was the family home
( 56%). Other locations for service
delivery included center- based set-tings
designed for children with or at
risk for developmental delay ( 30%),
hospitals, or other service provider
locations ( 9%) and community pro-grams
designed for typically develop-ing
children or other settings ( 5%).
A wide array of early intervention and
family support services are offered
through the FIT program; e. g. assis-tive
technology, speech, physical and
occupational therapies, family coun-seling,
audiology, transportation,
home and center- based instruction,
and vision services. The most fre-quently
accessed services are: ser-vice
coordination, evaluations, home
based developmental services, and
therapies.
When children reach age 3, many of
them transition into the public school
Outreach activities have increased num-bers
of children served over the previous
year.
special education program ( under
IDEA, Part B requirements). Nearly
one- third of the children who left
early intervention services during
FY 2000 were determined eligible
for special education services.
Developmental Disabilities Waiver
What Has Been Done?
• Increased the number of
individuals served by 250 people,
with allocations to 460.
• Sponsored a Self- Advocacy
Conference in New Mexico.
• Developed an outcome- based
Quality Management and
Improvement Process to monitor
services and provides data to
aide administration in planning.
• Supported self- advocates with
training on leadership.
• Increased job placements.
What Needs To Be Done?
• Develop a Self- Directed Care
model and pilot services.
• Design strategies to speed- up
access to services.
• Respond to advisory group input/
public comment for waiver
renewal reflecting needed
change.
• Revise Day Habilitation to
encourage community
integration and inclusion.
• Promote employment for
everyone with a disability who
wants a job.
• Develop DD services in the
community for criminal
offenders.
Condition/
Type of
Disability
% of
US
Popu-lation
Est. #
( US)
Est. #
( NM)
MR / DD 1.58 4,132,878 27,490
Cerebral
Palsy
0.40 1,049,322 6,959
Spina
Bifida
0.06 161,866 1,044
Autism 0.04 105,464 696
FIGURE 1d
Estimates of MR/ DD in the US and
New Mexico
It is estimated that 1.58% of people
living in the US have developmental
disabilities. This translates to ap-proximately
27,000 New Mexicans.
Since the late 1970’ s there has
been a national movement to pro-vide
services and supports in the
community for individuals with dis-abilities
rather than in institutions.
While there has been a significant
shift to community- based care na-
Page 10 Long Term Services Division
Fiscal Year 2000 Annual Report
A developmental disability is an
impairment or delay in physical
or mental development that occurs
before a person reaches age 22. A
person’s ability to perform a number
of major life activities may be lim-ited
due to the disability, and may
include things like bathing, dress-ing,
grooming; communicating with
others; moving or working without
assistance; and needing help to live
and work on one’s own. Individuals
with developmental disabilities vary
widely in the level of impairments
and the intensity and kind of help
they need in order to live in the
community.
tionwide, New Mexico is in the fore-front
in this area. It is one of only
seven states that has closed its large
state facilities for people with MR/
DD. Although the state continues to
provide long term care services
through small private Intermediate
Care Facilities for the Mentally Re-tarded
( ICF/ MR), the average daily
expenditure in 1999 was less than
one third of the national average in
this type of setting. However, New
Mexico ranks in the top ten percent
nationwide in terms of per capita
spending on individuals with develop-mental
disabilities, given the state’s
commitment to the DD Waiver pro-gram.
The DD Waiver program helps New
Mexicans with developmental dis-abilities
stay in their communities by
providing services that would other-wise
be provided in an institution,
such as help with cooking, grooming,
and working. The bulk of services for
individuals with developmental dis-abilities
in New Mexico are provided
through the home and community
based waiver program.
Spending on developmental disabili-ties
in New Mexico has moved from
funding more institutional settings to
funding most services in community
settings over the last two decades.
Since 1980, money to fund commu-nity
services have increased by
2472%. After peaking at just over
$ 44 million annually in 1992, spend-ing
on large institutions fell to zero in
1995 because all state- run institu-tions
were closed. Presently, 85% of
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
DID YOU KNOW ….
85% of New Mexicans
receiving DD services are in
home and community based
services versus ICF/ MR
care.
Trina Brillhart
Page 11
DID YOU KNOW ….
New Mexico is one of seven
states that no longer
operates any large state MR/
DD facilities.
FIGURE 2d
Spending for Large State- Run Institutions versus Community Services in New
Mexico by Revenue Source
Region FY 1999 FY 2000
Metro 901 1092
NW 185 192
NE 281 304
SW 274 311
SE 273 261
Total 1914 2160
FIGURE 3d
DD Waiver Recipients by LTSD Re-gion
( FY 2000)
individuals receiving DD services are
in home and community based ser-vices
versus ICF/ MR care.
As of year- end FY 2000, the DD
Waiver served 2160 individuals. An-other
2035 individuals were regis-tered
for services on the Central Reg-istry.
This comprises approximately
15% of the potential demand for DD
Waiver services. There are a num-ber
of explanations for the large dis-crepancy
between the number of
individuals registered for and receiv-ing
LTSD services and the potential
pool of eligible individuals. People
with less severe disabilities may not
seek services because they are able
to function relatively independently
and don’t need or want assistance.
Some individuals have extensive
family and other natural supports that
help them live independently. Others
receive help from agencies and or-ganizations
outside of the LTSD ser-vice
delivery system ( e. g. Salud! per-sonal
care option, EPSDT, Special
Education, private insurance, etc.).
Some are served by other LTSD pro-
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
1980 1984 1988 1992 1996 2000
Congregate/ Institutional Community Services
Some supports grant flexible relief
to caregivers while offering opportu-nities
for the individual with disabili-ties
to improve or maintain skills in
activities of daily living. Between
FY 1999 and FY 2000, most ser-vices
have expanded in number .
All increases in numbers in services
“ Ever since I moved into my
apartment I’ve learned a lot.
Everything from cooking to bal-ancing
and budgeting my own
checkbook. I’ve come a long
way from a long time ago.”
Marilyn Martinez
Self- Advocate
are, in part, a reflection of the 13%
growth in number served during the
year.
Access of therapy services ( physical
therapy, occupational therapy,
speech therapy, or nutrition counsel-ing)
was one of the most dramatic
trends in FY 2000. In addition, over
half of the individuals on the DD
Waiver accessed behavior therapy.
One of the LTSD’s priorities lies in its
Supported Employment Services.
Access of therapy services was one of the
most dramatic trends in DD Services in FY
2000
grams. Still others may not know
about services available to them.
LTSD has increased its outreach
efforts over the past year by distrib-uting
a new brochure and video
about LTSD programs.
Long Term Services Division
Fiscal Year 2000 Annual Report
Page 12
FIGURE 4d
Numbers of Individuals Receiving DD Waiver Services During FY 1999 and FY 2000
Individuals with disabilities who are
employed tend to have greater confi-dence
in themselves and their abili-ties,
tend to be more independent
and have greater opportunities for
interaction with community members
than their non- employed peers.
The philosophy embraced by LTSD
is that every individual who wants a
job should have one. FY 2000 data
indicate the number of individuals in
employment has increased by 24%
in the past year.
Day Habilitation services remain a
part of the lives of most of the indi-viduals
on the DD Waiver. The na-tional
trend is to move individuals
into integrated community settings
and out of congregate or segre-gated
day programs. The LTSD is
committed to improving the intensity
and individualization of its Habilita-tion
services.
Residential services are provided to
support individuals living as inde-pendently
as possible in the com-munity.
Congregate living refers to
four person homes and supervised
living ( more than 4 individuals).
Three out of four individuals served
by the DD Waiver receive residential
services. Though the total number
served on the DD Waiver increased
by ± 250, the number of individuals in
24- hour residential settings
( Supported Living) did not grow.
Growth in 24- hour residential sup-ports
occurred only in more cost-effective
options.
DD Services are available for people of all
ages
720
1533
1151
2160
14
2658
375
934
259
491
93
915
582
1476
989
1914
9
1778
437
836
239
445
56
920
Group or Individual Supported Employment
Habilitation
Behavior Therapy ( BT)
Case Management
Nursing
Therapies ( PT, OT, SLP, or Nutrition)
Personal Care
Respite
Assisted Living
Home Based or Companion Living
Other Congregate Living
Supported Living
2000 1999
“[ Forrest and Larry] .. both
work a variety of jobs they
choose. Both love their small
town, their living conditions,
their independence and learn-ing...
Both men are finally
happy and have a real life.”
Bryan Robinson
Guardian
State General Funded ( SGF) Services to Children and Adults
S tate General Funded services
include Respite for children and
adults with developmental disabilities,
and Residential and Vocational ser-vices
for adults with developmental
disabilities. State General services
are available only to people who are
not served by a Waiver program.
Respite services are provided so
families can take a break from the
daily routine of care giving. Respite
services can be provided a few hours
at a time or for several consecutive
days, depending upon family needs
and provider availability. The LTSD
community providers offered respite
services to almost 900 individuals in
FY 2000. The majority of recipients
are children.
Page 13
The number receiving respite grew
by approximately 50% during the
year, mostly due to a transfer of
funds when vacancies occurred in
the Adult Vocational services. A re-
Adult Residential and Vocational
Services provide a variety of sup-ports
in the home and workplace in
order to assist the adult with devel-opmental
disabilities to live more
independently in the community.
In SGF Residential services these
215
591
29
825
220
560
620
Adult Residential
Adult Vocational
Adult Behavior
Therapy
Children & Adult
Respite
FY00 FY99
FIGURE 1e
Numbers of Individuals Receiving SGF Services During FY 1999 and FY 2000
supports include supervision and
care at home, to the extent needed,
and other activities of daily living,
such as assistance with paying bills,
shopping and household mainte-nance.
In SGF Vocational services these
supports include on- the- job place-ment
and training, and community
supported employment, and habilita-tion
services.
127
101
31
15 11
Birth to Four Age 5 to 21 Age 22 to 44 Over Age 60 Age 45 to 60
FIGURE 2e
Numbers of Children and Adults Unable to Receive SGF Respite During FY
2000
SGF Services include Respite, Therapies,
Vocational and Residential supports.
For exact eligibility criteria,
please contact the LTSD toll free
at ( 877) 696- 1472.
cent survey of respite providers
shows a continued unmet need for
respite, particularly for children.
Disabled and Elderly Waiver
Long Term Services Division
Fiscal Year 2000 Annual Report
T he Disabled and Elderly
Waiver program is open to
individuals who are otherwise eligi-ble
for nursing home placement due
to a disabling condition but would
rather receive services at home.
Nationally there are over 35 million
people age 65 and older, almost 13
percent of the U. S. population. It is
anticipated the number of individu-als
age 65 and older will double by
2030 becoming 20% of the total
population. The percentage of
Americans 65 and older with
chronic disability was 21% in 1994,
as opposed to 24% in 1982. How-ever,
those age 85 and older com-prise
the fastest growing group of
elderly individuals. This rapid
growth represents in part a triumph,
but this age group also needs a
disproportionately large portion of
special services and public support,
including specialized housing,
transportation, recreation, health-care
and nutrition services. Despite
the decline in the number of elders
with chronic disability, it is expected
the need for long term care services
will continue to grow.
In FY 2000, 83% of New Mexico’s
Long Term Care funding went to
nursing facilities. Only 13% of fund-ing
was spent on Home and Com-munity
Based services. Both state
and national figures have a greater
percentage of individuals receiving
services at home, despite the fact
more is spent for nursing home
care. The average cost of nursing
facility care in New Mexico is
$ 39,073, while the average annual
cost of Home and Community
Based Waiver services is $ 17,000.
Fewer individuals are choosing
nursing home care . In 1997, 4.5%
of individuals 65 years and older re-sided
in nursing homes, as compared
to 5.4% in 1985.
Most people with Long Term Care
needs live at home; either in their
own homes, with or without a spouse,
or in the home of a close relative.
The D& E Waiver Program is de-signed
to help elderly and physically
disabled New Mexicans live at home.
Services and supports available
through the Waiver address the so-cial
and environmental needs of the
individual as well their medical
needs. In the home setting most
people receive “ home health care”,
which usually includes some skilled
nursing; personal services like bath-ing
and dressing; and help with
housework, like meal preparation and
What Has Been Done?
• In an effort to expand the
D& E Waiver, allocation
letters were sent to 1700
people.
• A rate increase was
approved for Nursing,
Homemaker/ Personal Care,
and Case Management
Services.
• A toll- free number was
added to allocation letters to
facilitate contact between
registrants and program
administrators.
• New procedures and joint
trainings to improve access
and get individuals into
services more quickly have
been developed by LTSD and
ISD.
• Adult Day Health Services
was added to the program.
What Needs To Be Done?
• Increase the number of
individuals assessed for
services in order to keep up
with the high rate of attrition.
• Offer a choice between
nursing home and D& E
Waiver placement with
available funds.
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
DID YOU KNOW ….
More than 7 million
Americans— mostly family
members— provide 120 million
hours of unpaid care to elders
with functional disabilities. If
these caregivers ere paid, the
cost would run from $ 45 billion
to $ 95 billion a year.
( ASPE and AoA, 1998)
Region FY 1999 FY 2000
Metro 371 360
NW 102 81
NE 407 584
SW 202 242
SE 286 268
Total 1368 1535
FIGURE 1f
D& E Waiver Recipients by LTSD Re-gion
( FY 2000)
Very Special Arts
Page 14
Page 15
Case Management services provide
assistance to individuals and their
families in identifying needs and link-ing
them to services.
Most people on the D& E Waiver use
Homemaker/ Personal Care and Res-pite
Services. These services help
the individual with activities of daily
living like: bathing and dressing, meal
planning and preparation, and house-work.
Respite services provide the
primary caregivers with time out from
caring for the person with disabilities.
Therapies and Assisted Living were
the least used services.
FIGURE 2f
Numbers of Individuals Receiving D& E Waiver Services During FY 1999 and FY 2000
Adult Day Health is a new service
that provides structured social and
rehabilitation activities including:
individual and group activities, as-sistance
with self- administration of
medications, assistance with toilet-ing,
mid- day meals, and transporta-tion.
Access to emergency response
services has grown by 50%. This
service provides 24- hour- a- day
electronic monitoring ( a telephone
emergency response line) for indi-viduals
who live alone and need
assistance in times of crisis. As-sisted
Living continues to be a sel-dom-
used service; it is the only
D& E residential service which is an
alternative to living in one’s own
“ I was very sick. I was very
depressed and very lonely.
The State sent Bernice to
help me. She helps clean my
house, talks to me, buys my
food. She is a wonderful girl.”
Aurora Tapia
DID YOU KNOW ….
Nearly all D& E Waiver services
are provided to individuals in
their own home.
laundry.
Despite services being offered to
1700 individuals, the number in ser-vice
only grew by fewer than 200
people in FY 2000. Of the applicants
to the D& E Waiver, typically about
35% accept services when notified of
their availability. There is significant
turnover on this Waiver due to the
age of most applicants.
“ El Senador”
35
1449
549
134
1404
595
65
1003
77
30
1368
360
50
1366
514
48
898
40
Assisted Living
Case Management
Emergency Response
Environmental Modifications
Homemaker or Personal Care
Nursing ( RN or LPN)
Personal Services or Adult Day Health
Respite
Therapies ( OT, PT, or SLP)
2000 1999
`
T he term “ medically fragile” re-fers
to chronic physical condi-tions
that require daily medical
treatment and skilled nursing care.
Some individuals receiving services
are medically dependent on tech-nology,
such as ventilators, dialysis
machines, continuous oxygen, etc.
New Mexico’s medically fragile defi-nition
also requires an individual to
have development disabilities or
developmental delays to qualify for
services.
What Has Been Done?
• Developed a pre- assessment
system.
• Completed the revision of the
definitions and standards for
the Waiver Renewal
application.
• Designed, pretested, and
revised a case management
client satisfaction survey.
Parents reported being
generally pleased with the
overall quality of case
management services.
What Needs To Be Done?
• Get approval for the Medically
Fragile Waiver renewal from
HCFA.
• Add the Medically Fragile
Waiver registration database to
the Central Registry.
• Complete a review of Waiver
funding caps based on levels of
care.
• Train on new definitions and
standards.
• Expand respite options beyond
an institutional setting to
private duty nursing and home
health aides.
• Coordinate with SALUD! for
equitable services for
medically fragile.
DID YOU KNOW ….
The infant mortality rate fell
34% between 1983 and 1998 in
the US.
Region FY 1999 FY 2000
Metro 64 67
NW 21 20
NE 30 32
SW 12 14
SE 14 16
Total 141 149
FIGURE 1g
Medically Fragile Waiver Recipi-ents
by LTSD Region ( FY 2000)
Medically Fragile Waiver
Long Term Services Division
Fiscal Year 2000 Annual Report
The nature of New Mexico’s defini-tion
for a medically fragile condition
makes it difficult to compare the
state’s small population with pro-grams
throughout the nation. In
general, it is known that individuals
who qualify for this program tend to
be children under age 18, and typi-cally
this program serves between
140- 160 individuals at any given
time. The number served has been
relatively constant for the past sev-eral
years.
As technology and medicine ad-vance,
the lives of individuals who
are medically fragile and their fami-lies
are strongly affected. It becomes
ever more feasible for individuals with
major medical needs to survive at
birth and live at home rather than
primarily in a hospital. With some
training, family members can do
much of the care, such as suctioning
and cleaning tubes. Nursing services
are highly valued for the relief pro-vided
to the primary caregivers.
The infant mortality rate fell 34% be-tween
1983 and 1998 in the US.
There has been a steady increase
nationwide in the number of low birth
weight babies ( newborns weighing
less than 2,500 grams) since the mid-eighties.
In 1998, New Mexico’s low
birth weight birth rate was 7.5% of all
live births. Some of these babies are
at risk for developing long- term dis-abilities.
As infant mortality rates
drop, some babies remain medically
fragile and require intensive medical
care on a daily basis. This is the
Medically Fragile Waiver’s target
population.
New Mexico launched the Medically
Fragile Program in 1985. According
to the 1998 Medically Fragile Waiver
System Quality Review, “ Parents
consistently report the services re-ceived
from this waiver enable them
to successfully maintain their family
unit.” Individuals who are medically
fragile are often at risk for hospitaliza-tion
and institutionalization. The
Medically Fragile program has been
successful in decreasing the number
and duration of hospitalizations
needed by these children. Aside
from the psychological and emotional
benefits being at home provides,
many children have enjoyed overall
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
The Medically Fragile Waiver provides
services for children who have develop-mental
disabilities and require intensive
medical care on a daily basis.
Page 16
Page 17
health improvement. They are in
greater contact with their loved ones,
so they typically receive more indi-vidualized
attention. By having a
child with a medically fragile condition
at home, families have many more
opportunities to interact as a whole.
Furthermore, the temporary relief
provided to caregivers through the
Waiver reduces the stress and ex-haustion
that can come from caring
for a child with intensive needs.
In addition to the support made avail-able
to help families stay together,
providers, direct support staff, and
case managers were praised in the
Quality Review as being committed,
creative, person– centered, knowl-edgeable,
goal- oriented, and respon-sible.
Age # Served
FY 1999
# Served
FY 2000
0- 4 32 39
5-- 20 91 94
21- 44 17 15
45- 60 1 1
Total 141 149
FIGURE 2g
Medically Fragile Waiver Recipi-ents
by Age Breakdown ( FY 2000)
FIGURE 3g
Numbers of Individuals Receiving Medically Fragile Waiver Services Dur-ing
FY 1999 and FY 2000
A variety of services are offered
through the Medically Fragile Waiver
Program. Case Management ser-vices
are provided by the University
of New Mexico, Center for Develop-ment
and Disabilities. Case Man-agers
( who must be Registered
Nurses) coordinate services for in-dividuals
through providers, such as
home health agencies, statewide.
Virtually all individuals with a medi-cally
fragile condition need Private
Duty Nursing services, provided by
a registered nurse ( RN) or licensed
practical nurse ( LPN). For simple
procedures like help with grooming,
dressing, cooking, exercise, ostomy
site care, laundry, etc., Home
Health Aide services are provided.
Most individuals on this waiver ac-cess
physical, occupational, or
speech therapy or nutritional coun-seling
as well. Temporary care to
give caregivers time- off to them-selves
was offered through Carrie
Tingley Hospital, and was accessed
by a few families.
“ You can do anything you want.
You can ride a bike, meet
friends... For those like me... do
not look back, always go for-ward.”
Joey Taylor
12 years old
Nearly all ( 90%) of all Medically Frag-ile
Waiver service recipients are 20
years old or younger. A small per-centage
fall within the 21 - 44 age
category with no elderly people in the
Waiver Program. Many individuals
who are medically fragile and devel-opmentally
disabled either pass away
or get better as they age, resulting in
many more children in services than
adults.
Many families can care for their medically
fragile children at home
188
217
98
184
140
150
60
141
Therapies ( PT, OT, SLP, Nutritional,
or Psychosocial)
Private Duty Nursing ( RN or LPN)
Home Health Aide
Case Management ( Assessment
and Ongoing)
2000 1999
Traumatic Brain Injury Services
What Has Been Done?
• Expanded services statewide.
• Increased number of case
management and service
providers.
What Needs To Be Done?
• Evaluate accountability of
current programs.
• Stop the incarceration of
injured adults as a substitute
for treatment.
• Offer more choice in provider
agencies.
• Offer a broader range of
services, such as behavior and
family counseling.
• Prompter service delivery from
the time of allocation.
T raumatic Brain Injury ( TBI) Ser-vices
in New Mexico are limited
to individuals who have received an
insult to the brain, caused by an ex-ternal
physical force, that produces
impairment in cognitive abilities or
physical functioning.
Nationwide, approximately 1.9 million
people sustain a brain injury every
year; 80,000 of these injuries pro-duce
a long- term disability. In New
Mexico there are approximately
1,870 new cases of serious or fatal
TBI each year, costing nearly $ 290
million in both public and private
funds annually. An estimated 79 new
cases of long term disability occur in
New Mexico each year as a result of
TBI. For people under age 44, TBI is
a leading cause of death and injury-related
disability in New Mexico.
Over the last decade there has been
a decrease in the incidence rate for
TBI, which may be attributable to
fewer brain injuries and/ or the fact
data is gathered only on individuals
who are hospitalized or die from
their injuries. From 1972 to 1992,
the rate of TBI- related deaths de-creased
by 22%. In addition, inju-ries
related to motor vehicle
crashes decreased by 25% be-tween
1984 and 1992. This de-crease
may be the result of public
awareness and prevention projects.
However, firearm- related injuries
jumped 13% during the same pe-riod,
making firearm injuries the
largest single cause of death asso-ciated
with traumatic brain injury in
the United States in 1990.
The Brain Injury Service Fund
( BISF) provides services to indi-viduals
with a TBI. To qualify for
services, New Mexico residents
must have a physician’s diagnosis
of traumatic brain injury and meet
LTSD financial eligibility require-ments.
Funding for this program
comes from legislative appropria-tions
and the $ 5 fee attached to
each traffic ticket issued to motor-ists.
Combined funding is approxi-mately
$ 1,810,000 annually. Traffic
tickets generate about $ 130,000 in
revenue each month.
Eligible individuals may receive up
to $ 25,000 a year ( a $ 75,000 life-time
maximum) to purchase neces-sary
services. The TBI Program
provides Case Management, Life
Skills Training and Crisis Interim
346
153
230
142
81
132
Case Management
Life Skills Training
Crisis/ Interim Services
2000 1999
FIGURE 1h
Numbers of Individuals Receiving BISF Services During FY 1999 and FY 2000
For exact eligibility criteria,
please contact the LTSD toll free
at ( 877) 696- 1472.
Services.
Case Manage-ment
services
are offered to
TBI Program
participants.
The case man-ager
assists
individuals and
their families in
identifying
needs and link-ing
them to ser-vices.
Life
Skills Training Services provides
training to people with TBI and their
families. This training focuses on
improving the individual’s ability to
perform daily living tasks like: manag-ing
money and medications, meal
planning and cooking, doing laundry
and cleaning, using community re-sources,
and maintaining control
when angry. Crisis Interim Services
are available to help individuals with
TBI deal with major life changes.
Service may include: the purchase of
special equipment, environmental
modifications, retrofitting an automo-bile,
transportation, therapies, pre-scribed
medication, and others. In
FY 2000 the BISF provided a total of
$ 727,590 in crisis interim services
( up from $ 150,000 in FY 1999).
As of June 30, 2000 a total of 535
individuals received services and
supports through the TBI Program,
and 103 applicants were registered
on the Central Registry.
Eligible individuals can
receive Case Manage-ment,
Life Skills Train-ing,
and Crisis Interim
Services
Long Term Services Division
Fiscal Year 2000 Annual Report
Page 18
Page 19
Los Lunas Community Program
The Los Lunas Community Program
( LLCP) provides an array of Develop-mental
Disabilities Waiver services
including: Supported Living, Home
Based Living, Supported Employ-ment,
Day Habilitation, Dental Ser-vices,
Crisis services and therapies
( OT, PT, SLP, BT). The Program
specializes in providing services and
supports to individuals with medically
fragile conditions and individuals with
significant behavioral challenges.
In May, 2000 the LLCP opened a
Secured Facility. This attractive
home is situated on 22 acres of land
with a secured perimeter, west of
Belen, New Mexico. A Day Habilita-tion
program has also been estab-lished
on this site. Currently two indi-viduals
receive services through this
facility. The total served will increase
to five individuals over the course of
next year.
The LLCP currently provides residen-tial
services to 132 individuals. This
component of the program has grown
by 30% since 1998 when 92 individu-als
were served.
People come from all over the state
to receive Dental Services from Dr.
Ray Lyons and his staff at LLCP.
Annually, 650 individual patients
receive their dental services from
this program.
The LLCP also provides statewide
Crisis Intervention Services, using a
three- tiered response to crisis situa-tions.
The first level response is to
provide support to the individual in
their home through training, mentor-ing
and consultation by LLCP. The
second level response is to send
LLCP direct care staff to the home
to relieve the staff dealing with a
crisis situation in the home. As the
situation stabilizes, direct care staff
for the home are mentored and pro-vided
training. The third level re-sponse
is to provide up to four
months of living supports and thera-pies
in an LLCP home, while work-ing
to return the individual to their
home and community. In the last
92
102
132
1998 1999 2000
FIGURE 1i
Numbers of Individuals With Residential Supports through the LLCP During FY
1998, 1999, and 2000
year over 60 crisis interventions were
delivered to individuals throughout
the state.
Therapies are also provided state-wide.
Last year over 450 individuals
received their Occupational Therapy,
Physical Therapy and Speech Ther-apy
through the LLCP. The LLCP
also provides Behavioral Therapy to
individuals in the Metro Region of the
state.
The LLCP is the only state- operated
( by LTSD) community program serv-ing
individuals with developmental
disabilities through a comprehensive
array of community- based services.
This program reflects a successful
transition of institutional services to a
community- based direct service pro-gram.
LLCP also serves as a safety net for
individuals with developmental dis-abilities
through statewide support
services such as the Crisis Interven-tion
Program.
For exact eligibility criteria,
please contact the LTSD toll free
at ( 877) 696- 1472.
Long Term Services Division
Fiscal Year 2000 Annual Report
Page 20
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Term Services Division, 2000.
Traumatic Brain Injury Services Report.
New Mexico Department of Health, Long
Term Services Division, October 1999.
Disabled and Elderly Services
Aging and Developmental Disabilities:
Demographic and Policy Issues Affecting
American Families. University of Illinois
at Chicago, Department of Disability and
Human Development, September 1998.
Presented by David Braddock.
Aging into the 21st Century. Administra-tion
on Aging, 2000: « http://
www. aoa. dhhs. gov/ aoa/ stats/ aging21/
health. html »
American Association of Retired Per-sons.
Reforming the Health Care Sys-tem:
State Profiles 1999.
Census Brief. U. S. Department of Com-merce,
Economics and Statistics Admini-stration,
Bureau of the Census, Decem-ber
1997.
Challenges and Opportunities for States
in Providing Long- Term Care for the Eld-erly.
National Governors’ Association
Center for Best Practices, Health Policy
Studies Division, 2000.
Disabled and Elderly Incidence, Preva-lence
and Trends 2000. New Mexico De-partment
of Health, Long Term Services
Division, 2000.
Disabled and Elderly Waiver Report, New
Mexico Department of Health, Long Term
Services Division, August 2000.
Older Americans 2000: Key Indicators of
Well- Being. Administration on Aging,
2000: « http:// www. agingstats. gov »
Robyn I. Stone. Long- Term Care for the
Elderly with Disabilities: Current Policy,
Emerging Trends, and Implications for
the Twenty- First Century. Milbank Memo-rial
Fund, 2000.
The State of Health In New Mexico 1999
Report. New Mexico Department of
Health, Public Health Division, Office of
Epidemiology, 1999.
What is Alzheimers Disease? Alzheim-ers.
com, 2000: « http://
www. alzheimers. com/ health_ library/
basics/ basics_ 01_ what. html »
Glossary
Brain Injury Service Fund ( BISF):
provides services and supports to
individuals with a traumatic brain in-jury.
D& E Waiver: offers home and com-munity-
based services for those indi-viduals
who want to live at home.
DD Waiver: a home and community
based alternative to institutionaliza-tion
in an intermediate care facility for
the mentally retarded ( ICF/ MR).
Developmental Disability ( DD): an
impairment or delay in physical or
mental development that occurs be-fore
the age of 22.
Disabled and Elderly ( D& E) refers to
persons with a disability ( disabled as
determined by the Disability Determi-nation
Unit utilizing Social Security
Guidelines) or persons age 65 or
older.
EPSDT: Early Periodic Screening
Diagnosis and Treatment ( a Medicaid
Program), provided for children birth
to age 19.
Family Infant Toddler ( FIT) Pro-gram:
provides early intervention ser-vices
to families of children birth to
three years of age who have or who
are at risk for developmental delay.
FY: Fiscal Year
Gap Program: provides services to
individuals who are physically dis-abled
needing short- term crisis or
interim services and goods to indi-viduals
to increase or maintain their
independence, or avoid institutionali-zation,
or move from an institution.
IDEA, Part B: The Individuals with
Disabilities Education Act, Part B pro-vides
special education and related
services to children from age three to
twenty one, who have a disability.
IDEA, Part C: The Individuals with
Disabilities Education Act, Part C is
a program that supports families
who have an infant or toddler from
birth to age three, who have or who
are at risk for developmental delays.
IFSP: An Individualized Family Ser-vice
Plan is the process and docu-ment
through which the family, the
service coordinator and their team
plan for the outcomes to work to-wards
for the child and family and
the services needed to reach those
outcomes.
Intermediate Care Facility for the
Mentally Retarded ( ICF/ MR): pro-vides
active treatment in a residen-tial
setting and includes all needed
services for mentally retarded indi-viduals
or persons with related con-ditions
whose mental or physical
condition require services on a
regular basis that can only be pro-vided
in a facility which is equipped
and staffed to provide the appropri-ate
services.
ISD: Income Support Division, Hu-man
Services Department
The Long Term Services Division
( LTSD): Within the New Mexico
Department of Health ( DOH), the
LTSD administers three Medicaid
Waiver Programs: the Develop-mental
Disabilities Waiver, the
Medically Fragile Waiver, and the
Disabled and Elderly Medicaid
Waiver, as well as the FIT Program,
Traumatic Brain Injury Program, and
State General Funded services.
LPN: Licensed Practical Nurse
MAD: Medical Assistance Division,
Human Services Department
Medically Fragile: refers to chronic
physical conditions that require daily
medical treatment and skilled nurs-ing
care.
Medically Fragile Waiver: offers
services for individuals who have
been determined prior to the age of
22 to be both medically fragile and
developmentally disabled, develop-mentally
delayed or at risk for devel-opmental
delay.
OT: Occupational Therapy
PT: Physical Therapy
RN: Registered Nurse
ST/ SLP: Speech Therapy
State General Fund ( SGF): are ap-propriations
made by the NM Legisla-ture.
Traumatic Brain Injury ( TBI): char-acterized
by an insult to the brain
caused by an external force, that pro-duces
impairment of cognitive abilities
or physical functioning.
Home and Community Based services help
individuals with disabilities go places and
do things as any another community mem-ber
Page 21

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Continued by: New Mexico. Dept. of Health. Developmental Disabilities Supports Division.

Transcript

Department of Health
Long Term Services Division
Annual Report
Fiscal Year 2000
July 1, 1999 through June 30, 2000
*
“ Los Remedios”
Inside This Report
Introduction to the Long Term Services Division 3
Central Registry 6
Family Infant Toddler Program 8
Developmental Disabilities Waiver 10
State General Fund— Children and Adults 13
Disabled and Elderly Waiver 14
Medically Fragile Waiver 16
Traumatic Brain Injury Services 18
Bibliography 19
Glossary 20
Artwork
Cover
“ Los Remedios”, Detail, 1996
Artist: Glenn Strock
Courtesy of La Familia Medical Center
Page 3
“ Best Friend” 1999
Watercolor
Artist: Helene Valdez
Courtesy of Very Special Arts
Page 10
Trina Brillhart 2000
Photograph, hand- made paper frame
Courtesy of Very Special Arts
Page 13
“ Untitled”, 10/ 2000
Designer: Joe Stephenson
Painters: Christina Caraveo, Ian Donaldson, Casey Ferguson, Carlan Gettman, Rachel Hardy, Cindy Luna,
Pete Martindale, Diana Phillips, Linda Plageman, Adam Smith, Joe Tenorio, Chris Travis, Hoka Skenandore,
Sandy Ward, Melvin Lucero, Tal Maya’an, Damian Moya
Courtesy of Very Special Arts
Page 14
“ El Senador”, Detail, 1999
Artists: Cynthia and J. Mark Rowland
Public Art Program
Urban Enhancement Fund
Page 2 Long Term Services Division
Fiscal Year 2000 Annual Report
Visit us on the Internet:
www. health. state. nm. us/ ltsd/ index. html
A bout 1 in 5 Americans have
some kind of disability, and 1
in 10 have a severe disability. Typi-cally,
the person who takes on the
role of primary helper for the person
with a disability is a relative. As a
person grows older, the likelihood
of having a severe disability in-creases.
About 250,000 New Mexicans have
a disabling condition and about half
of these individuals have a severe
disability. While not all of these indi-viduals
need long term care ser-vices,
their needs most likely mean
the involvement of family members
as decision- makers and providers
of care. Families can benefit from
long term care interventions be-cause
the care for the person with a
disability gives assistance and relief
for family caregivers.
Introduction to the Long Term Services Division
The role of the Long Term Services
Division ( LTSD) is to promote the
potential of the individual with or at
risk for a disability to live at home
within their families and communi-ties.
Services are wide- ranging: job
support; family counseling; thera-pies
to promote independence in
physical activities; communication
skill- building; assistance or training
with basic activities of daily living,
like bathing, dressing, eating,
household chores like meal prepa-ration,
or activities in the commu-nity,
such as work, shopping, and
What Has Been Done?
• A greater number of children and
adults received services through all
programs managed by the LTSD.
• Results of a cost study led to rate
changes, and in most cases
increases, in funding for certain
services.
• A quality management/ improvement
system was designed in collaboration
with the Division of Health
Improvement to review provider
services and overall performance.
• More adults with developmental
disabilities had jobs in the community.
• Improvements to the DD Waiver
Central Registry data system resulted
in better information for and about
applicants .
• Improvements to the FIT Database
resulted in better information about
birth to three year olds in Early
Intervention Services.
• Adults with disabilities were provided
with opportunities to be self-advocates
and form self- advocacy
support groups.
• Quarterly newsletters were published
• A video and brochure on the benefits
of LTSD services and supports were
developed and distributed.
What Needs To Be Done?
• Increase the number of people in all
programs.
• Give parents and consumers a chance
to manage their own services.
• Improve accountability from ourselves
and our providers for quality services.
• Promote inclusion and delivery of
services in natural – or community --
settings.
• Move closer to a settlement of the
Jackson class action lawsuit.
• Give families and consumers a
greater voice in advising state
government --- establish a consumer
council and a children’s advisory
council.
• Train providers to improve
understanding of performance
expectations.
• Coordinate for a smooth transition of
the Disabled and Elderly Waiver
Program to the Human Services
Department.
• Prepare for federal monitoring of
Waivers and Health Insurance
Portability and Accountability Act
requirements.
Mission Statement
The mission of the Long Term Services Division is to provide
services that promote quality life outcomes for persons with
disabilities and their families.
DID YOU KNOW…..
One out of every three people
in America over the age of 65
has a severe disability.
transportation, and other services.
Long term care may be provided in a
variety of settings – from 24- hour
residential/ day services to living inde-pendently
in one’s own home -- de-pending
upon the individual’s needs
and preferences, along with the avail-ability
of informal supports.
New Mexico is one of only seven
states in the nation that have closed
its publicly- funded institutions for
people with developmental disabili-ties.
As an alternative, individuals
who were previously- institutionalized
now receive services in their home
and community through the Develop-mental
Disabilities Waiver Program.
A conservative estimate of the num-ber
of people in New Mexico with a
developmental disability ( based on a
prevalence rate of 1.58%) is approxi-
Page 3
“ Best Friend”
mately 27,000
individuals of all
ages. Many of
these individuals
are school- age,
and receive
needed services
and supports
through the pub-lic
schools until
21 years of age.
Many others are
older New Mexi-cans,
living with
elderly caregiv-ers.
When life
transitions result in loss of supports,
these individuals pose a challenge to
funding agencies, such as LTSD.
Another challenge to LTSD is that
New Mexico is a large, predominantly
rural state. In rural frontier counties,
opportunities for education, employ-ment,
accessible transportation, tele-communications
are limited. Finding
qualified personnel who live in rural
areas, or who are willing to travel to
frontier counties, is a challenge to
long term care service providers.
Page 4 Long Term Services Division
Fiscal Year 2000 Annual Report
DID YOU KNOW…..
Almost 2 out of 3 counties in
New Mexico are frontier
counties ( that is, fewer than 6
people per square mile), which
experience the full impact of
rural isolation and remoteness.
LTSD provided long term care ser-vices
to approximately 8400 chil-dren
and adults. This represents a
10% growth in numbers served
over the year.
Since LTSD serves all geographic
areas of New Mexico, 58% of its
staff are distributed in regional of-fices,
rather than the central Santa
Fe base.
Budget resources ( including federal
Medicaid match) totaled $ 187 mil-lion
for the year. Of this amount,
94% is spent on services through
provider contracts. The largest
LTSD program is the Developmen-tal
Disabilities ( DD) Waiver, with
67% of the program budget; fol-lowed
by the Disabled and Elderly
Waiver Program, then by the FIT
Program.
In addition to contracts with ap-proximately
240 service providers,
the Division operates the Los Lunas
Community Program. LLCP serves
The Community Services Bureau
manages contracts/ agreements with
service providers for these funding
sources: DD Waiver, D& E Waiver,
Medically Fragile Waiver, Traumatic
Brain Injury, Gap Fund, and Adult
State General Fund. Responsibilities
include: development of program re-
D& E Waiver
13%
FIT Program
6%
Adult SGF
Services
4%
MF
Waiver
3%
TBI
1%
Administration
6%
DD Waiver
67%
STRUCTURE OF THE DIVISION
In the fiscal year beginning July 1999
through June 2000 ( FY 2000), the
Location Positions
Santa Fe Central Office 45
Albuquerque Metro
Office
30
Roswell
( Southeast Region)
8
Las Cruces
( Southwest Region)
9
Taos ( Northeast Region) 8
Gallup
( Northwest Region)
6
Total 106
FIGURE 1a
Geographic Distribution of LTSD Staff
FIGURE 2a
Budget Resources for FY 2000
DID YOU
KNOW…..
New Mexico is
the 11th fastest-growing
state
in the nation.
The fastest-growing
age
group in NM is
those over 65
years of age.
as a “ safety net” of crisis intervention
services, as well as a direct service
provider in the Metro and Northwest
Regions, dental, and therapies/
assistive technology services state-wide
for people with developmental
disabilities.
Page 5
quirements and oversight of service
provider compliance with require-ments
of various funding sources.
The Family Infant Toddler ( FIT)
Program provides a statewide sys-tem
of services and supports, using
three sources of funding: Medicaid,
State General and federal education
funds. Under the federal IDEA, Part
C program, LTSD is responsible for
assuring that all eligible children ages
birth to three receive appropriate
evaluations, services coordination
and early intervention services in a
timely manner. The unit has respon-sibilities
for public awareness, infor-mation
management and tracking,
eligibility determinations and meeting
requirements for a qualified person-nel
workforce. In addition, the pro-gram
manages a state- funded respite
program for children, birth to age 18,
with or at- risk for disabilities.
Regional Offices provide technical
assistance to service providers on
appropriate implementation of ser-vices.
Other responsibilities include
providing information to the public
and people in services, and follow- up
on incidences of abuse, neglect and
exploitation.
Located in the five regional offices,
the staff of Resource Supports pro-vide
training and technical assistance
to service providers, specializing in
the areas of case management, sup-ported
employment, behavioral sup-ports,
and individualized services and
supports. This unit manages a pre-service
and in- service training pro-gram,
inclusive of a tracking system
for private- sector employee compli-ance
with training requirements, for
DD Waiver providers. Individual ad-vocacy
services include mediation,
dispute resolution, coordination of
self- advocacy initiatives with people
in services. This unit plays a key role
in the implementation of the settle-ment
agreement for the Jackson law-
Program Area Provider Technical
Staff-
Trained
Assistance
Early
Childhood
1,773 Data Un-available
Supported
Employment
585 2,379
Individual
Advocacy
196 75
Competency
Training
11,877 1,145
Case
Management
79 179
Total( s) 14,510 3,778
FIGURE 3a
Training and Technical Assistance
suit. Competency training for case
managers and direct service staff in
community programs providing DD
Waiver services included entry- level
topics, as well as specialized topics
such as crisis intervention, medical
aspects, development of individual
service plans, and confidentiality.
Training and technical assistance
are provided by staff throughout the
Division, as well as training con-tracts.
One arm of the Program Develop-ment
Bureau facilitates strategic
planning in partnership with advi-sory
councils, develops status re-ports
on services and people with
disabilities, and produces the quar-terly
newsletter. The other arm of
this Bureau maintains the Central
Registry ( applicants for services)
and eligibility for the three Waiver
programs, as well as nursing home
placement for people with develop-mental
disabilities.
Two functions are performed under
Administrative Services: financial
supports and information/ data man-agement.
Financial supports in-clude
personnel, property and lease
management, purchasing, accounts
payable, fiscal grants management,
contracts management, and budg-eting.
Information/ data management
supports include communications,
data base applications and report
generation.
Key functions of the Division are:
• Public awareness and edu-cation
on services, access,
and program requirements
• Determination of eligibility for
services
• Development/ management
of contracts for services in
local communities statewide
• Quality management and
improvement, including
evaluation of service provid-ers
• Leadership in design and
implementation of statewide
supports, such as staff train-ing.
Tia Nelis encourages self- advocates to
speak for themselves and develop their
own leadership.
What Has Been Done?
• Developed a Pre-assessment
Case
Management service for
Disabled & Elderly Waiver
and Medically Fragile
Waiver registrants to keep
the Central Registry
information accurate and to
inform individuals about
LTSD services and other
services they can access
immediately.
• Changed the Central
Registry software making it
more user- friendly and
allowing access by the
Regional Offices.
• Added ICF/ MR ( Intermediate
Care Facility for the
Mentally Retarded) referrals
and admissions to the
Central Registry.
• Disseminated new Outreach
materials including the
LTSD Brochure and Video.
What Needs To Be Done?
• Examine demographic
trends and changing
service needs identified
through the Central
Registry to use in planning
services.
Central Registry
T he LTSD’s Central Registry is
a database used to manage
registration and allocation to the DD
Waiver, D& E Waiver, Medically
Fragile Waiver, DD State General
Fund services, and Intermediate
Care Facilities for the Mentally Re-tarded
( ICF/ MR). Information is
constantly changing as new indi-viduals
register and existing regis-trants
move into services.
Page 6 Long Term Services Division
Fiscal Year 2000 Annual Report
FIGURE 1b
Comparison of FY 99 and FY 2000 Individuals Actively Waiting For the DD and
D& E Waivers ( Counts are duplicative)
1917 2035
3027
2405
DD D& E
FY 99 FY 2000
Note: These numbers reflect the duplication of 1337 individuals registered for both Waiv-ers.
Individuals begin the registration
process at their local ISD County
Office. The ISD Office forwards the
registration information to the LTSD
Regional Office for assessment to
determine whether the individual
matches the criteria for the program
requested. An individual can regis-ter
for any or all programs for which
they believe they may meet eligibil-ity
criteria. Many individuals regis-tered
for both the DD and D& E
Waivers ( 1337 in FY 2000), result-
From FY 1999 to FY 2000, registra-tions
for DD services increased by
approximately 6%. The number of
registrants on the D& E Waiver Cen-tral
Registry was decreased by 21%
in the same period. In FY 2000, 464
persons were allocated into DD ser-vices
and 1700 into D& E services.
ing in a duplicate of 4440 registra-tions
for both programs. Allocations
are made based on registration date
and elderly caregiver status.
The LTSD sponsored New Mexico’s first
Self- Advocacy Conference
“ The general public should be
educated to know people with
special needs can still func-tion
in society.”
Lana Von Tress
Parent
Page 7
Most of registered applicants for the
D& E Waiver ( 64%) are aged 65
years and older. Children and
young adults generally register for
the DD Waiver because services
are a better fit, e. g. supported em-ployment,
the number of respite
hours allowed.
FIGURE 2b
Number of Individuals Registered for
DD Waiver Services By Age During FY
2000
FIGURE 3b
Number of Individuals Registered
for D& E Waiver Services By Age
During FY 2000
33
30
9
4
2
4
9
5
0 thru
3
4 thru
12
13 thru
17
18 thru
21
22 thru
34
35 thru
49
50 thru
64
65 and
Older
FIGURE 4b
Number of Individuals Registered for
MF Waiver Services By Age During FY
2000
The Medically Fragile Medicaid
Waiver Program had significantly
fewer registrants than the other Waiv-ers.
Ninety- six individuals registered
for that program in FY 2000.
The percentage of children registered
for the Medically Fragile Waiver is
81%. Adults must have a develop-mental
disability to meet the eligibility
criteria for the Medically Fragile
Waiver.
Children make up 43% of registrants
for the DD Waiver. There are very
few individuals in the 65 and older
category since the LTSD has a prior-ity
to serve applicants with elderly
caregivers.
“[ LTSD staff] help people get
out of nursing homes, get at-tendants
to provide personal
care, and assist people in go-ing
back to school: real ser-vices
that make a significant
difference in the lives of New
Mexicans with disabilities.”
Susan Lewis
Self- Advocate
DID YOU KNOW…..
In 1992, 15% of the total
US noninstitutionalized
population reported some
activity limitation due to
Participants enjoyed dancing at the Self- chronic health conditions.
Advocacy Conference.
102
411
360
292
517
254
78
21
0 thru 3
4 thru
12
13 thru
17
18 thru
21
22 thru
34
35 thru
49
50 thru
64
65 and
Older
32
34
21
23
109
261
376
1549
0 thru 3
4 thru
12
13 thru
17
18 thru
21
22 thru
34
35 thru
49
50 thru
64
65 and
Older
What Has Been Done?
• Developed an Improvement
Plan in response to U. S.
Department of Education
Monitoring Report.
• Over 300 Developmental
Specialist staff have been
certified.
• Over 300 Service Coordinator
staff have attended training.
• Published the FIT Program
Web Pages on the Internet.
• Modified child evaluation &
assessment system to
increase access and
appropriateness.
• Developed and implemented
the t h r ee year ICC
( Interagency Coordinating
Council) Strategic Plan.
• Developed an Interagency
Transition Agreement.
What Needs To Be Done?
• Establish special population
service initiatives.
• Implement the New Mexico
IDEA Part C Improvement Plan.
• Design and pilot a system of
monitoring and program
evaluation for the FIT Program.
• Continue work on the redesign
of the FIT financial system to
maximize resources and
support quality practices in
service delivery.
• Pilot IFSP- IEP document in
collaboration with State
Department of Education.
T he Family Infant
Toddler Program of
the LTSD is the lead
agency in New Mexico
providing early interven-tion
services to families of children
birth to three who have or who are
at risk for developmental delay.
The FIT program is responsible for
meeting the requirements of the
federal Individuals with Disabilities
Education Act ( IDEA) Part ' C'
through a multi- agency system of
services and supports.
Early Intervention services promote
a child's learning and development
during the important period of birth
through three years of age. The
FIT Program offers early interven-tion
services to eligible families
through over 30 early intervention
service providers across New Mex-ico.
Services are funded through a
combination of State, Medicaid and
federal IDEA Part C funds. Early
Family Infant Toddler ( FIT) Program
Page 8 Long Term Services Division
Fiscal Year 2000 Annual Report
Families, in collaboration with a team
of professionals, develop an Individu-alized
Family Service Plan ( IFSP).
The IFSP strategies, including ser-vices
and supports, are designed to
achieve family identified outcomes
through increasing the family’s ca-pacity
to meet the special needs of
the child.
FIGURE 1c
Number of Children and Families Referred for Services During FY 2000 by
Source of Referral
DID YOU KNOW…
Recent advances in brain
research indicate ninety percent
( 90%) of a child’s brain growth
occurs during the first three years
of life.
33
37
71
75
105
120
136
156
518
576
Navajo Nation
Childcare Worker
Public Health Division ( not CMS)
Early Intervention Provider
Social Service Agencies
Family / Friend
Educational Agencies
Children's Medical Services ( CMS)
Parents
Medical Care Personnel
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
Intervention services are also sup-ported
through agreements with the
State Department of Education, the
Children Youth and Families Depart-ment,
the Navajo Nation, State sup-ported
schools, and Headstart.
The FIT Program does not maintain a
list of applicants or have children
waiting for services. Services are
available in local communities state-
The FIT Program serves families of eligible wide.
children birth to three
Page 9
FIGURE 2c
Number of Children Determined Eligible in FY 1999 & FY 2000
( subset of the total number receiving services as children may have been
evaluated in a different year)
187
427
933
173
158
240
807
113
At risk,
Environmental
At Risk,
Medical/ Biological
Developmental
Delay
Established
Condition
FY 2000 FY 1999
During FY 2000 the FIT Program
served 3,057 eligible children, ap-proximately
3% of the general
population of children birth through
three years old. Children and fami-lies
served were located throughout
New Mexico, roughly proportionate
to the general population distribu-tion
of the state. Most children
were identified for services after
turning age two. The Family Infant
DID YOU KNOW…
Every dollar invested in quality
early childhood development
saves society $ 7 in remedial
education, welfare payments
and court and prison
expenses.
High/ Scope Perry
Preschool Study, 1994
“ When I started with the pro-gram
of early intervention, I
started becoming aware of the
opportunities… ( my daughter)
had to advance, to develop, and
to do what she is doing now.”
Blanca Hernandez
Parent
Region FY 1999 FY 2000
Metro 776 934
NW 327 457
NE 509 531
SW 580 671
SE 312 464
Total 2504 3057
* FY99 count contains potential duplicates.
FIGURE 3c
FIT Recipients by LTSD Region
Toddler Program conducted outreach
activities in FY 2000 which have re-sulted
in increased numbers of chil-dren
served over the previous year.
Most children are in services be-cause
of a delay in their develop-ment.
However, an increasing num-ber
of children are being identified
who have a medical condition, such
as low birthweight, which puts them
at risk for a developmental delay.
Services are delivered in the home,
childcare settings or other community
locations. The primary location for
the delivery of services, as specified
on the Individualized Family Service
Plans ( IFSPs) developed during fiscal
year 2000 was the family home
( 56%). Other locations for service
delivery included center- based set-tings
designed for children with or at
risk for developmental delay ( 30%),
hospitals, or other service provider
locations ( 9%) and community pro-grams
designed for typically develop-ing
children or other settings ( 5%).
A wide array of early intervention and
family support services are offered
through the FIT program; e. g. assis-tive
technology, speech, physical and
occupational therapies, family coun-seling,
audiology, transportation,
home and center- based instruction,
and vision services. The most fre-quently
accessed services are: ser-vice
coordination, evaluations, home
based developmental services, and
therapies.
When children reach age 3, many of
them transition into the public school
Outreach activities have increased num-bers
of children served over the previous
year.
special education program ( under
IDEA, Part B requirements). Nearly
one- third of the children who left
early intervention services during
FY 2000 were determined eligible
for special education services.
Developmental Disabilities Waiver
What Has Been Done?
• Increased the number of
individuals served by 250 people,
with allocations to 460.
• Sponsored a Self- Advocacy
Conference in New Mexico.
• Developed an outcome- based
Quality Management and
Improvement Process to monitor
services and provides data to
aide administration in planning.
• Supported self- advocates with
training on leadership.
• Increased job placements.
What Needs To Be Done?
• Develop a Self- Directed Care
model and pilot services.
• Design strategies to speed- up
access to services.
• Respond to advisory group input/
public comment for waiver
renewal reflecting needed
change.
• Revise Day Habilitation to
encourage community
integration and inclusion.
• Promote employment for
everyone with a disability who
wants a job.
• Develop DD services in the
community for criminal
offenders.
Condition/
Type of
Disability
% of
US
Popu-lation
Est. #
( US)
Est. #
( NM)
MR / DD 1.58 4,132,878 27,490
Cerebral
Palsy
0.40 1,049,322 6,959
Spina
Bifida
0.06 161,866 1,044
Autism 0.04 105,464 696
FIGURE 1d
Estimates of MR/ DD in the US and
New Mexico
It is estimated that 1.58% of people
living in the US have developmental
disabilities. This translates to ap-proximately
27,000 New Mexicans.
Since the late 1970’ s there has
been a national movement to pro-vide
services and supports in the
community for individuals with dis-abilities
rather than in institutions.
While there has been a significant
shift to community- based care na-
Page 10 Long Term Services Division
Fiscal Year 2000 Annual Report
A developmental disability is an
impairment or delay in physical
or mental development that occurs
before a person reaches age 22. A
person’s ability to perform a number
of major life activities may be lim-ited
due to the disability, and may
include things like bathing, dress-ing,
grooming; communicating with
others; moving or working without
assistance; and needing help to live
and work on one’s own. Individuals
with developmental disabilities vary
widely in the level of impairments
and the intensity and kind of help
they need in order to live in the
community.
tionwide, New Mexico is in the fore-front
in this area. It is one of only
seven states that has closed its large
state facilities for people with MR/
DD. Although the state continues to
provide long term care services
through small private Intermediate
Care Facilities for the Mentally Re-tarded
( ICF/ MR), the average daily
expenditure in 1999 was less than
one third of the national average in
this type of setting. However, New
Mexico ranks in the top ten percent
nationwide in terms of per capita
spending on individuals with develop-mental
disabilities, given the state’s
commitment to the DD Waiver pro-gram.
The DD Waiver program helps New
Mexicans with developmental dis-abilities
stay in their communities by
providing services that would other-wise
be provided in an institution,
such as help with cooking, grooming,
and working. The bulk of services for
individuals with developmental dis-abilities
in New Mexico are provided
through the home and community
based waiver program.
Spending on developmental disabili-ties
in New Mexico has moved from
funding more institutional settings to
funding most services in community
settings over the last two decades.
Since 1980, money to fund commu-nity
services have increased by
2472%. After peaking at just over
$ 44 million annually in 1992, spend-ing
on large institutions fell to zero in
1995 because all state- run institu-tions
were closed. Presently, 85% of
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
DID YOU KNOW ….
85% of New Mexicans
receiving DD services are in
home and community based
services versus ICF/ MR
care.
Trina Brillhart
Page 11
DID YOU KNOW ….
New Mexico is one of seven
states that no longer
operates any large state MR/
DD facilities.
FIGURE 2d
Spending for Large State- Run Institutions versus Community Services in New
Mexico by Revenue Source
Region FY 1999 FY 2000
Metro 901 1092
NW 185 192
NE 281 304
SW 274 311
SE 273 261
Total 1914 2160
FIGURE 3d
DD Waiver Recipients by LTSD Re-gion
( FY 2000)
individuals receiving DD services are
in home and community based ser-vices
versus ICF/ MR care.
As of year- end FY 2000, the DD
Waiver served 2160 individuals. An-other
2035 individuals were regis-tered
for services on the Central Reg-istry.
This comprises approximately
15% of the potential demand for DD
Waiver services. There are a num-ber
of explanations for the large dis-crepancy
between the number of
individuals registered for and receiv-ing
LTSD services and the potential
pool of eligible individuals. People
with less severe disabilities may not
seek services because they are able
to function relatively independently
and don’t need or want assistance.
Some individuals have extensive
family and other natural supports that
help them live independently. Others
receive help from agencies and or-ganizations
outside of the LTSD ser-vice
delivery system ( e. g. Salud! per-sonal
care option, EPSDT, Special
Education, private insurance, etc.).
Some are served by other LTSD pro-
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
1980 1984 1988 1992 1996 2000
Congregate/ Institutional Community Services
Some supports grant flexible relief
to caregivers while offering opportu-nities
for the individual with disabili-ties
to improve or maintain skills in
activities of daily living. Between
FY 1999 and FY 2000, most ser-vices
have expanded in number .
All increases in numbers in services
“ Ever since I moved into my
apartment I’ve learned a lot.
Everything from cooking to bal-ancing
and budgeting my own
checkbook. I’ve come a long
way from a long time ago.”
Marilyn Martinez
Self- Advocate
are, in part, a reflection of the 13%
growth in number served during the
year.
Access of therapy services ( physical
therapy, occupational therapy,
speech therapy, or nutrition counsel-ing)
was one of the most dramatic
trends in FY 2000. In addition, over
half of the individuals on the DD
Waiver accessed behavior therapy.
One of the LTSD’s priorities lies in its
Supported Employment Services.
Access of therapy services was one of the
most dramatic trends in DD Services in FY
2000
grams. Still others may not know
about services available to them.
LTSD has increased its outreach
efforts over the past year by distrib-uting
a new brochure and video
about LTSD programs.
Long Term Services Division
Fiscal Year 2000 Annual Report
Page 12
FIGURE 4d
Numbers of Individuals Receiving DD Waiver Services During FY 1999 and FY 2000
Individuals with disabilities who are
employed tend to have greater confi-dence
in themselves and their abili-ties,
tend to be more independent
and have greater opportunities for
interaction with community members
than their non- employed peers.
The philosophy embraced by LTSD
is that every individual who wants a
job should have one. FY 2000 data
indicate the number of individuals in
employment has increased by 24%
in the past year.
Day Habilitation services remain a
part of the lives of most of the indi-viduals
on the DD Waiver. The na-tional
trend is to move individuals
into integrated community settings
and out of congregate or segre-gated
day programs. The LTSD is
committed to improving the intensity
and individualization of its Habilita-tion
services.
Residential services are provided to
support individuals living as inde-pendently
as possible in the com-munity.
Congregate living refers to
four person homes and supervised
living ( more than 4 individuals).
Three out of four individuals served
by the DD Waiver receive residential
services. Though the total number
served on the DD Waiver increased
by ± 250, the number of individuals in
24- hour residential settings
( Supported Living) did not grow.
Growth in 24- hour residential sup-ports
occurred only in more cost-effective
options.
DD Services are available for people of all
ages
720
1533
1151
2160
14
2658
375
934
259
491
93
915
582
1476
989
1914
9
1778
437
836
239
445
56
920
Group or Individual Supported Employment
Habilitation
Behavior Therapy ( BT)
Case Management
Nursing
Therapies ( PT, OT, SLP, or Nutrition)
Personal Care
Respite
Assisted Living
Home Based or Companion Living
Other Congregate Living
Supported Living
2000 1999
“[ Forrest and Larry] .. both
work a variety of jobs they
choose. Both love their small
town, their living conditions,
their independence and learn-ing...
Both men are finally
happy and have a real life.”
Bryan Robinson
Guardian
State General Funded ( SGF) Services to Children and Adults
S tate General Funded services
include Respite for children and
adults with developmental disabilities,
and Residential and Vocational ser-vices
for adults with developmental
disabilities. State General services
are available only to people who are
not served by a Waiver program.
Respite services are provided so
families can take a break from the
daily routine of care giving. Respite
services can be provided a few hours
at a time or for several consecutive
days, depending upon family needs
and provider availability. The LTSD
community providers offered respite
services to almost 900 individuals in
FY 2000. The majority of recipients
are children.
Page 13
The number receiving respite grew
by approximately 50% during the
year, mostly due to a transfer of
funds when vacancies occurred in
the Adult Vocational services. A re-
Adult Residential and Vocational
Services provide a variety of sup-ports
in the home and workplace in
order to assist the adult with devel-opmental
disabilities to live more
independently in the community.
In SGF Residential services these
215
591
29
825
220
560
620
Adult Residential
Adult Vocational
Adult Behavior
Therapy
Children & Adult
Respite
FY00 FY99
FIGURE 1e
Numbers of Individuals Receiving SGF Services During FY 1999 and FY 2000
supports include supervision and
care at home, to the extent needed,
and other activities of daily living,
such as assistance with paying bills,
shopping and household mainte-nance.
In SGF Vocational services these
supports include on- the- job place-ment
and training, and community
supported employment, and habilita-tion
services.
127
101
31
15 11
Birth to Four Age 5 to 21 Age 22 to 44 Over Age 60 Age 45 to 60
FIGURE 2e
Numbers of Children and Adults Unable to Receive SGF Respite During FY
2000
SGF Services include Respite, Therapies,
Vocational and Residential supports.
For exact eligibility criteria,
please contact the LTSD toll free
at ( 877) 696- 1472.
cent survey of respite providers
shows a continued unmet need for
respite, particularly for children.
Disabled and Elderly Waiver
Long Term Services Division
Fiscal Year 2000 Annual Report
T he Disabled and Elderly
Waiver program is open to
individuals who are otherwise eligi-ble
for nursing home placement due
to a disabling condition but would
rather receive services at home.
Nationally there are over 35 million
people age 65 and older, almost 13
percent of the U. S. population. It is
anticipated the number of individu-als
age 65 and older will double by
2030 becoming 20% of the total
population. The percentage of
Americans 65 and older with
chronic disability was 21% in 1994,
as opposed to 24% in 1982. How-ever,
those age 85 and older com-prise
the fastest growing group of
elderly individuals. This rapid
growth represents in part a triumph,
but this age group also needs a
disproportionately large portion of
special services and public support,
including specialized housing,
transportation, recreation, health-care
and nutrition services. Despite
the decline in the number of elders
with chronic disability, it is expected
the need for long term care services
will continue to grow.
In FY 2000, 83% of New Mexico’s
Long Term Care funding went to
nursing facilities. Only 13% of fund-ing
was spent on Home and Com-munity
Based services. Both state
and national figures have a greater
percentage of individuals receiving
services at home, despite the fact
more is spent for nursing home
care. The average cost of nursing
facility care in New Mexico is
$ 39,073, while the average annual
cost of Home and Community
Based Waiver services is $ 17,000.
Fewer individuals are choosing
nursing home care . In 1997, 4.5%
of individuals 65 years and older re-sided
in nursing homes, as compared
to 5.4% in 1985.
Most people with Long Term Care
needs live at home; either in their
own homes, with or without a spouse,
or in the home of a close relative.
The D& E Waiver Program is de-signed
to help elderly and physically
disabled New Mexicans live at home.
Services and supports available
through the Waiver address the so-cial
and environmental needs of the
individual as well their medical
needs. In the home setting most
people receive “ home health care”,
which usually includes some skilled
nursing; personal services like bath-ing
and dressing; and help with
housework, like meal preparation and
What Has Been Done?
• In an effort to expand the
D& E Waiver, allocation
letters were sent to 1700
people.
• A rate increase was
approved for Nursing,
Homemaker/ Personal Care,
and Case Management
Services.
• A toll- free number was
added to allocation letters to
facilitate contact between
registrants and program
administrators.
• New procedures and joint
trainings to improve access
and get individuals into
services more quickly have
been developed by LTSD and
ISD.
• Adult Day Health Services
was added to the program.
What Needs To Be Done?
• Increase the number of
individuals assessed for
services in order to keep up
with the high rate of attrition.
• Offer a choice between
nursing home and D& E
Waiver placement with
available funds.
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
DID YOU KNOW ….
More than 7 million
Americans— mostly family
members— provide 120 million
hours of unpaid care to elders
with functional disabilities. If
these caregivers ere paid, the
cost would run from $ 45 billion
to $ 95 billion a year.
( ASPE and AoA, 1998)
Region FY 1999 FY 2000
Metro 371 360
NW 102 81
NE 407 584
SW 202 242
SE 286 268
Total 1368 1535
FIGURE 1f
D& E Waiver Recipients by LTSD Re-gion
( FY 2000)
Very Special Arts
Page 14
Page 15
Case Management services provide
assistance to individuals and their
families in identifying needs and link-ing
them to services.
Most people on the D& E Waiver use
Homemaker/ Personal Care and Res-pite
Services. These services help
the individual with activities of daily
living like: bathing and dressing, meal
planning and preparation, and house-work.
Respite services provide the
primary caregivers with time out from
caring for the person with disabilities.
Therapies and Assisted Living were
the least used services.
FIGURE 2f
Numbers of Individuals Receiving D& E Waiver Services During FY 1999 and FY 2000
Adult Day Health is a new service
that provides structured social and
rehabilitation activities including:
individual and group activities, as-sistance
with self- administration of
medications, assistance with toilet-ing,
mid- day meals, and transporta-tion.
Access to emergency response
services has grown by 50%. This
service provides 24- hour- a- day
electronic monitoring ( a telephone
emergency response line) for indi-viduals
who live alone and need
assistance in times of crisis. As-sisted
Living continues to be a sel-dom-
used service; it is the only
D& E residential service which is an
alternative to living in one’s own
“ I was very sick. I was very
depressed and very lonely.
The State sent Bernice to
help me. She helps clean my
house, talks to me, buys my
food. She is a wonderful girl.”
Aurora Tapia
DID YOU KNOW ….
Nearly all D& E Waiver services
are provided to individuals in
their own home.
laundry.
Despite services being offered to
1700 individuals, the number in ser-vice
only grew by fewer than 200
people in FY 2000. Of the applicants
to the D& E Waiver, typically about
35% accept services when notified of
their availability. There is significant
turnover on this Waiver due to the
age of most applicants.
“ El Senador”
35
1449
549
134
1404
595
65
1003
77
30
1368
360
50
1366
514
48
898
40
Assisted Living
Case Management
Emergency Response
Environmental Modifications
Homemaker or Personal Care
Nursing ( RN or LPN)
Personal Services or Adult Day Health
Respite
Therapies ( OT, PT, or SLP)
2000 1999
`
T he term “ medically fragile” re-fers
to chronic physical condi-tions
that require daily medical
treatment and skilled nursing care.
Some individuals receiving services
are medically dependent on tech-nology,
such as ventilators, dialysis
machines, continuous oxygen, etc.
New Mexico’s medically fragile defi-nition
also requires an individual to
have development disabilities or
developmental delays to qualify for
services.
What Has Been Done?
• Developed a pre- assessment
system.
• Completed the revision of the
definitions and standards for
the Waiver Renewal
application.
• Designed, pretested, and
revised a case management
client satisfaction survey.
Parents reported being
generally pleased with the
overall quality of case
management services.
What Needs To Be Done?
• Get approval for the Medically
Fragile Waiver renewal from
HCFA.
• Add the Medically Fragile
Waiver registration database to
the Central Registry.
• Complete a review of Waiver
funding caps based on levels of
care.
• Train on new definitions and
standards.
• Expand respite options beyond
an institutional setting to
private duty nursing and home
health aides.
• Coordinate with SALUD! for
equitable services for
medically fragile.
DID YOU KNOW ….
The infant mortality rate fell
34% between 1983 and 1998 in
the US.
Region FY 1999 FY 2000
Metro 64 67
NW 21 20
NE 30 32
SW 12 14
SE 14 16
Total 141 149
FIGURE 1g
Medically Fragile Waiver Recipi-ents
by LTSD Region ( FY 2000)
Medically Fragile Waiver
Long Term Services Division
Fiscal Year 2000 Annual Report
The nature of New Mexico’s defini-tion
for a medically fragile condition
makes it difficult to compare the
state’s small population with pro-grams
throughout the nation. In
general, it is known that individuals
who qualify for this program tend to
be children under age 18, and typi-cally
this program serves between
140- 160 individuals at any given
time. The number served has been
relatively constant for the past sev-eral
years.
As technology and medicine ad-vance,
the lives of individuals who
are medically fragile and their fami-lies
are strongly affected. It becomes
ever more feasible for individuals with
major medical needs to survive at
birth and live at home rather than
primarily in a hospital. With some
training, family members can do
much of the care, such as suctioning
and cleaning tubes. Nursing services
are highly valued for the relief pro-vided
to the primary caregivers.
The infant mortality rate fell 34% be-tween
1983 and 1998 in the US.
There has been a steady increase
nationwide in the number of low birth
weight babies ( newborns weighing
less than 2,500 grams) since the mid-eighties.
In 1998, New Mexico’s low
birth weight birth rate was 7.5% of all
live births. Some of these babies are
at risk for developing long- term dis-abilities.
As infant mortality rates
drop, some babies remain medically
fragile and require intensive medical
care on a daily basis. This is the
Medically Fragile Waiver’s target
population.
New Mexico launched the Medically
Fragile Program in 1985. According
to the 1998 Medically Fragile Waiver
System Quality Review, “ Parents
consistently report the services re-ceived
from this waiver enable them
to successfully maintain their family
unit.” Individuals who are medically
fragile are often at risk for hospitaliza-tion
and institutionalization. The
Medically Fragile program has been
successful in decreasing the number
and duration of hospitalizations
needed by these children. Aside
from the psychological and emotional
benefits being at home provides,
many children have enjoyed overall
For exact eligibility criteria,
please contact the LTSD toll
free at ( 877) 696- 1472.
The Medically Fragile Waiver provides
services for children who have develop-mental
disabilities and require intensive
medical care on a daily basis.
Page 16
Page 17
health improvement. They are in
greater contact with their loved ones,
so they typically receive more indi-vidualized
attention. By having a
child with a medically fragile condition
at home, families have many more
opportunities to interact as a whole.
Furthermore, the temporary relief
provided to caregivers through the
Waiver reduces the stress and ex-haustion
that can come from caring
for a child with intensive needs.
In addition to the support made avail-able
to help families stay together,
providers, direct support staff, and
case managers were praised in the
Quality Review as being committed,
creative, person– centered, knowl-edgeable,
goal- oriented, and respon-sible.
Age # Served
FY 1999
# Served
FY 2000
0- 4 32 39
5-- 20 91 94
21- 44 17 15
45- 60 1 1
Total 141 149
FIGURE 2g
Medically Fragile Waiver Recipi-ents
by Age Breakdown ( FY 2000)
FIGURE 3g
Numbers of Individuals Receiving Medically Fragile Waiver Services Dur-ing
FY 1999 and FY 2000
A variety of services are offered
through the Medically Fragile Waiver
Program. Case Management ser-vices
are provided by the University
of New Mexico, Center for Develop-ment
and Disabilities. Case Man-agers
( who must be Registered
Nurses) coordinate services for in-dividuals
through providers, such as
home health agencies, statewide.
Virtually all individuals with a medi-cally
fragile condition need Private
Duty Nursing services, provided by
a registered nurse ( RN) or licensed
practical nurse ( LPN). For simple
procedures like help with grooming,
dressing, cooking, exercise, ostomy
site care, laundry, etc., Home
Health Aide services are provided.
Most individuals on this waiver ac-cess
physical, occupational, or
speech therapy or nutritional coun-seling
as well. Temporary care to
give caregivers time- off to them-selves
was offered through Carrie
Tingley Hospital, and was accessed
by a few families.
“ You can do anything you want.
You can ride a bike, meet
friends... For those like me... do
not look back, always go for-ward.”
Joey Taylor
12 years old
Nearly all ( 90%) of all Medically Frag-ile
Waiver service recipients are 20
years old or younger. A small per-centage
fall within the 21 - 44 age
category with no elderly people in the
Waiver Program. Many individuals
who are medically fragile and devel-opmentally
disabled either pass away
or get better as they age, resulting in
many more children in services than
adults.
Many families can care for their medically
fragile children at home
188
217
98
184
140
150
60
141
Therapies ( PT, OT, SLP, Nutritional,
or Psychosocial)
Private Duty Nursing ( RN or LPN)
Home Health Aide
Case Management ( Assessment
and Ongoing)
2000 1999
Traumatic Brain Injury Services
What Has Been Done?
• Expanded services statewide.
• Increased number of case
management and service
providers.
What Needs To Be Done?
• Evaluate accountability of
current programs.
• Stop the incarceration of
injured adults as a substitute
for treatment.
• Offer more choice in provider
agencies.
• Offer a broader range of
services, such as behavior and
family counseling.
• Prompter service delivery from
the time of allocation.
T raumatic Brain Injury ( TBI) Ser-vices
in New Mexico are limited
to individuals who have received an
insult to the brain, caused by an ex-ternal
physical force, that produces
impairment in cognitive abilities or
physical functioning.
Nationwide, approximately 1.9 million
people sustain a brain injury every
year; 80,000 of these injuries pro-duce
a long- term disability. In New
Mexico there are approximately
1,870 new cases of serious or fatal
TBI each year, costing nearly $ 290
million in both public and private
funds annually. An estimated 79 new
cases of long term disability occur in
New Mexico each year as a result of
TBI. For people under age 44, TBI is
a leading cause of death and injury-related
disability in New Mexico.
Over the last decade there has been
a decrease in the incidence rate for
TBI, which may be attributable to
fewer brain injuries and/ or the fact
data is gathered only on individuals
who are hospitalized or die from
their injuries. From 1972 to 1992,
the rate of TBI- related deaths de-creased
by 22%. In addition, inju-ries
related to motor vehicle
crashes decreased by 25% be-tween
1984 and 1992. This de-crease
may be the result of public
awareness and prevention projects.
However, firearm- related injuries
jumped 13% during the same pe-riod,
making firearm injuries the
largest single cause of death asso-ciated
with traumatic brain injury in
the United States in 1990.
The Brain Injury Service Fund
( BISF) provides services to indi-viduals
with a TBI. To qualify for
services, New Mexico residents
must have a physician’s diagnosis
of traumatic brain injury and meet
LTSD financial eligibility require-ments.
Funding for this program
comes from legislative appropria-tions
and the $ 5 fee attached to
each traffic ticket issued to motor-ists.
Combined funding is approxi-mately
$ 1,810,000 annually. Traffic
tickets generate about $ 130,000 in
revenue each month.
Eligible individuals may receive up
to $ 25,000 a year ( a $ 75,000 life-time
maximum) to purchase neces-sary
services. The TBI Program
provides Case Management, Life
Skills Training and Crisis Interim
346
153
230
142
81
132
Case Management
Life Skills Training
Crisis/ Interim Services
2000 1999
FIGURE 1h
Numbers of Individuals Receiving BISF Services During FY 1999 and FY 2000
For exact eligibility criteria,
please contact the LTSD toll free
at ( 877) 696- 1472.
Services.
Case Manage-ment
services
are offered to
TBI Program
participants.
The case man-ager
assists
individuals and
their families in
identifying
needs and link-ing
them to ser-vices.
Life
Skills Training Services provides
training to people with TBI and their
families. This training focuses on
improving the individual’s ability to
perform daily living tasks like: manag-ing
money and medications, meal
planning and cooking, doing laundry
and cleaning, using community re-sources,
and maintaining control
when angry. Crisis Interim Services
are available to help individuals with
TBI deal with major life changes.
Service may include: the purchase of
special equipment, environmental
modifications, retrofitting an automo-bile,
transportation, therapies, pre-scribed
medication, and others. In
FY 2000 the BISF provided a total of
$ 727,590 in crisis interim services
( up from $ 150,000 in FY 1999).
As of June 30, 2000 a total of 535
individuals received services and
supports through the TBI Program,
and 103 applicants were registered
on the Central Registry.
Eligible individuals can
receive Case Manage-ment,
Life Skills Train-ing,
and Crisis Interim
Services
Long Term Services Division
Fiscal Year 2000 Annual Report
Page 18
Page 19
Los Lunas Community Program
The Los Lunas Community Program
( LLCP) provides an array of Develop-mental
Disabilities Waiver services
including: Supported Living, Home
Based Living, Supported Employ-ment,
Day Habilitation, Dental Ser-vices,
Crisis services and therapies
( OT, PT, SLP, BT). The Program
specializes in providing services and
supports to individuals with medically
fragile conditions and individuals with
significant behavioral challenges.
In May, 2000 the LLCP opened a
Secured Facility. This attractive
home is situated on 22 acres of land
with a secured perimeter, west of
Belen, New Mexico. A Day Habilita-tion
program has also been estab-lished
on this site. Currently two indi-viduals
receive services through this
facility. The total served will increase
to five individuals over the course of
next year.
The LLCP currently provides residen-tial
services to 132 individuals. This
component of the program has grown
by 30% since 1998 when 92 individu-als
were served.
People come from all over the state
to receive Dental Services from Dr.
Ray Lyons and his staff at LLCP.
Annually, 650 individual patients
receive their dental services from
this program.
The LLCP also provides statewide
Crisis Intervention Services, using a
three- tiered response to crisis situa-tions.
The first level response is to
provide support to the individual in
their home through training, mentor-ing
and consultation by LLCP. The
second level response is to send
LLCP direct care staff to the home
to relieve the staff dealing with a
crisis situation in the home. As the
situation stabilizes, direct care staff
for the home are mentored and pro-vided
training. The third level re-sponse
is to provide up to four
months of living supports and thera-pies
in an LLCP home, while work-ing
to return the individual to their
home and community. In the last
92
102
132
1998 1999 2000
FIGURE 1i
Numbers of Individuals With Residential Supports through the LLCP During FY
1998, 1999, and 2000
year over 60 crisis interventions were
delivered to individuals throughout
the state.
Therapies are also provided state-wide.
Last year over 450 individuals
received their Occupational Therapy,
Physical Therapy and Speech Ther-apy
through the LLCP. The LLCP
also provides Behavioral Therapy to
individuals in the Metro Region of the
state.
The LLCP is the only state- operated
( by LTSD) community program serv-ing
individuals with developmental
disabilities through a comprehensive
array of community- based services.
This program reflects a successful
transition of institutional services to a
community- based direct service pro-gram.
LLCP also serves as a safety net for
individuals with developmental dis-abilities
through statewide support
services such as the Crisis Interven-tion
Program.
For exact eligibility criteria,
please contact the LTSD toll free
at ( 877) 696- 1472.
Long Term Services Division
Fiscal Year 2000 Annual Report
Page 20
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Glossary
Brain Injury Service Fund ( BISF):
provides services and supports to
individuals with a traumatic brain in-jury.
D& E Waiver: offers home and com-munity-
based services for those indi-viduals
who want to live at home.
DD Waiver: a home and community
based alternative to institutionaliza-tion
in an intermediate care facility for
the mentally retarded ( ICF/ MR).
Developmental Disability ( DD): an
impairment or delay in physical or
mental development that occurs be-fore
the age of 22.
Disabled and Elderly ( D& E) refers to
persons with a disability ( disabled as
determined by the Disability Determi-nation
Unit utilizing Social Security
Guidelines) or persons age 65 or
older.
EPSDT: Early Periodic Screening
Diagnosis and Treatment ( a Medicaid
Program), provided for children birth
to age 19.
Family Infant Toddler ( FIT) Pro-gram:
provides early intervention ser-vices
to families of children birth to
three years of age who have or who
are at risk for developmental delay.
FY: Fiscal Year
Gap Program: provides services to
individuals who are physically dis-abled
needing short- term crisis or
interim services and goods to indi-viduals
to increase or maintain their
independence, or avoid institutionali-zation,
or move from an institution.
IDEA, Part B: The Individuals with
Disabilities Education Act, Part B pro-vides
special education and related
services to children from age three to
twenty one, who have a disability.
IDEA, Part C: The Individuals with
Disabilities Education Act, Part C is
a program that supports families
who have an infant or toddler from
birth to age three, who have or who
are at risk for developmental delays.
IFSP: An Individualized Family Ser-vice
Plan is the process and docu-ment
through which the family, the
service coordinator and their team
plan for the outcomes to work to-wards
for the child and family and
the services needed to reach those
outcomes.
Intermediate Care Facility for the
Mentally Retarded ( ICF/ MR): pro-vides
active treatment in a residen-tial
setting and includes all needed
services for mentally retarded indi-viduals
or persons with related con-ditions
whose mental or physical
condition require services on a
regular basis that can only be pro-vided
in a facility which is equipped
and staffed to provide the appropri-ate
services.
ISD: Income Support Division, Hu-man
Services Department
The Long Term Services Division
( LTSD): Within the New Mexico
Department of Health ( DOH), the
LTSD administers three Medicaid
Waiver Programs: the Develop-mental
Disabilities Waiver, the
Medically Fragile Waiver, and the
Disabled and Elderly Medicaid
Waiver, as well as the FIT Program,
Traumatic Brain Injury Program, and
State General Funded services.
LPN: Licensed Practical Nurse
MAD: Medical Assistance Division,
Human Services Department
Medically Fragile: refers to chronic
physical conditions that require daily
medical treatment and skilled nurs-ing
care.
Medically Fragile Waiver: offers
services for individuals who have
been determined prior to the age of
22 to be both medically fragile and
developmentally disabled, develop-mentally
delayed or at risk for devel-opmental
delay.
OT: Occupational Therapy
PT: Physical Therapy
RN: Registered Nurse
ST/ SLP: Speech Therapy
State General Fund ( SGF): are ap-propriations
made by the NM Legisla-ture.
Traumatic Brain Injury ( TBI): char-acterized
by an insult to the brain
caused by an external force, that pro-duces
impairment of cognitive abilities
or physical functioning.
Home and Community Based services help
individuals with disabilities go places and
do things as any another community mem-ber
Page 21